Changing therapeutic landscape - The last decade

Undoubtedly the most important event in the previous decade in lymphoma treatment was the establishment of immunotherapy as a prime modality. Addition of rituximab improves survival in almost every group of patients with CD20+ tumors. This has led to the appearance of a number of "me too" monoclonal antibodies (MoAbs) as well as MoAbs directed against other antigens whose usefulness remains to be proven during the next decade. We have also seen the raise and, probably unwarranted, fall of radioimmunotherapy. Conventional radiotherapy is losing ground. Regarding chemotherapy, the success of attempts to supplant R-CHOP-21 for front-line treatment of DLBCL with more dose-dense or dose-intense regimens remains doubtful and this issue is still unresolved. Bendamustine appeared as possibly the most effective cytotoxic agent for treatment of indolent lymphomas, while treatment of HL is becoming more tailored to prognostic features. This decade has also seen the advent of targeted drugs for lymphoma treatment. Their real impact will become known in the years to come. Finally, we may hope that advances in understanding the biology of lymphomas, made in the last decade, will help resolve remaining critical issues, treatment of T-NHLs and high-risk DLBCLs, being probably the most prominent

Antimicrobial Treatment of Periodontal Diseases

U ovom se članku ocjenjuje vrijednost sustavne protumikrobne terapije bolesti parodonta. Poznavati tip parodontne infekcije može biti važno u izboru protumikrobne terapije. Protumikrobno liječenje treba prilagoditi razlikama u osjetljivosti na antibiotike pojedinih parodontnih patogena. U literaturi je opisano mnogo različitih vrsta antibiotske terapije što otežava odluku o izboru antibiotika u kliničkoj praksi. Vrijednost sustavne upotrebe antibiotika u zaustavljanju progresije parodontnih bolesti ispitana je u mnogobrojnim studijama. Glavni kandidati za antibiotsku terapiju jesu pacijenti kojima konvencionalnom mehaničkom terapijom nije zaustavljeno napredovanje bolesti. Opravdana je upotreba i u bolesnika s lokaliziranim agresivnim parodontitisom ili drugim rano razvijenim oblicima bolesti, te u pacijenata sa sustavskim bolestima koje utječu na parodontitis. Dokazano je da kao dodatak uobičajenoj terapiji može poboljšati ishod liječenja. Ozbiljne nuspojave koje sa sobom donosi sustavna uporaba antibiotika, kao što su razvoj rezistencije, te porast oportunističkih mikroorganizama, ne opravdavaju rutinsku uporabu antibiotika u liječenju kroničnih, sporoprogredirajućih oblika parodontnih bolesti.This paper presents a critical evaluation of the use of systemic antimicrobial treatment in periodontal disease. Recognizing specific types of periodontal infections can significantly influence the choice of antimicrobial treatment. Therapy should be tailored to differences in antibiotic susceptibility between various periodontal pathogens. Many different antibiotic regimens have been described in the literature, making the choice in clinical practice difficult. Numerous studies have examined the impact of systemic antibiotic treatment in stopping the progression of periodontal diseases. Major candidates for antibiotic therapy are patients whose disease continues to progress despite conventional mechanical treatment. Antibiotics can also be used in patients with localized aggressive or other early developed forms of periodontitis, as well as in patients with systemic diseases affecting the course of periodontitis. They have proven to be beneficial as an adjunct to standard therapy. Serious side-effects of systemic antibiotic treatment, such as development of resistance and increase in opportunistic microorganisms, do not justify their use in the treatment of chronic, slowly-progressive forms of periodontal diseases

NON-TECHNICAL COMPETENCIES REQUIRED FOR INFORMATION TECHNOLOGY PROFESSIONALS: HOW TO EFFECTIVELY INTERACT WITH CLIENTS/USERS

After considering reasons for developing the competencies of information technology (IT) professionals, so me of their key non-technical competencies are identified and discussed. Focusing on competence in their communicative interactions, results are presented from a survey which was performed to identify specific components of competence in interaction with clients/users. A total of 150 traits was evaluated by 424 IT professionals. Four factors have been found to contribute lo competence in interaction with clients/users: (1) work effectiveness; (2) productive information exchange; (3) agreeableness; and (4) sales related characteristics. Results are interpreted in relation to the demands of the professional environment of IT personnel

Post-Traumatic Stress Disorder Patients and Periodontal Health

Progresija parodontitisa ovisi o istodobnoj pojavi nekoliko čimbenika bolesti. Osim mikroorganizama subgingivnoga plaka pokazano je da stres, promjenom odgovora domaćina, pridonosi destrukciji tkiva u parodontnoj bolesti. Ratni stres može izazvati trajne posljedice, uključujući posttraumatski stresni poremećaj (PTSP). Željeli smo ispitati prevalenciju nekih parodontnih patogena, povezanost tih mikroorganizama s kliničkim parametrima parodontitisa i utjecaj ratnoga stresa na parodontno zdravlje u pacijenata s PTSP-om. Istraživanje je provedeno na 130 ispitanika: 50 ratnih veterana oboljelih i liječenih od PTSP-a, 50 osoba s progresivnim parodontitisom (PP) i 30 parodontno zdravih osoba. Skupina s progresivnim parodontitisom uključuje oboljele od kroničnog (CO) i agresivnog (AP) parodontitisa. Jedino je skupina ratnih veterana bila neposredno izložena ratnome stresu. Proveden je potanki parodontni pregled i uzeti su uzorci subgingivne mikroflore svakog ispitanika. Klinički pregled je uključivao određivanje plak indeksa (PI), indeksa krvarećeg sulkusa (SBI), dubinu sondiranja (PD) i klinički gubitak pričvrstka (CAL). Metoda lančane reakcije polimeraze (PCR) upotrijebljena je za identifikaciju sljedećih bakterija: Actinobacillus actinomycetemcomitans(Aa), Porphyromonas gingivalis (Pg) i Eikenella corrodens (Es). Prevalencija u svim skupinama za Ec bila je 81% , za Aa 36% i za Pg 19%. Prevalencija za Ec bila je 74% u PTSP skupni, 80% u PP skupni i 93% u parodontno zdravih ispitanika. Prevalencija za Aa bila je 30% u PTSP skupini, 46% u PP skupini i 30% u parodontno zdravih ispitanika. Prevalencija za Pg bila je 16% u PTSP skupini, 16% u PP skupini i 26% u kontrolnoj skupini. S obzirom na vrstu parodontitisa prevalencija bakterija bila je : za Ec 74% u CP i 83% u AP pacijenata; za Aa 37% u CP i 39% u Ap pacijenata; za Pg 16% u CP i 18% u AP pacijnata. Ispitanici s Ec imali su niže PI, SBI i CAL vrijednosti. Oboljeli od PTSP-a imali su najveće PI i SBI vrijednosti, a bili su slični PP pacijentima po PD i CAL vrijednostima. Slična prevalencija parodontnih patogena u PTSP i PP pacijenata pokazuje da se oboljeli od PTSP-a mogu smatrati rizičnom skupinom za inicijaciju i progresiju parodontne bolesti.Progression of periodontitis depends on simultaneous occurrence of several factors of the disease. Besides subgingival plaque microorganisms, stress, through modifying host response, has been shown to contribute to tissue destruction seen in periodontal disease. War stress can cause permanent effects, including post-traumatic stress dosorder (PTSD). We wanted to study the prevalence of periodontal pathogens, association of these microorganisms with the clinical parameters of periodontitis and the influence of war stress on periodontal health in patients with PTSD. The investigation was conducted on 130 subjects: 50 war veterans diagnosed and treated for PTSD, 50 subjects with progressive periodontitis (PP) and 30 periodontally healthy subjects. The progressive periodontitis group included subjects with chronic (CP) and agressive peiodontitis (AP). Only the war veterans group has been exposed directly to war stress. Detailed periodontal examination and subgingival microbial ampling were conducted for each participant. Clinical examination included assessment of plaque index (PI), sulcus bleeding index (SBI), probing depth (PD) and clinical attachment loss (CAL). Polymerase chain reaction (PCR) was used for microbial identification of the following bacteria: Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg) and Eikenella corrodens (Ec). The prevalence in all groups for Ec was 81%, for Aa 36% and for Pg 19%. Prevalence for Ec was 74% in PTSD group, 80% in PP group and 93% in periodontally healthy subjects. Prevalence for Aa was 30% in PTSD group, 46% in PP group and 30% in periodontally healthy subjects. Prevalence of Pg was 16% in PTSD group, 16% in PP group and 26% in the control gorup. Considering the periodontal diagnosis, the prevalence of bacteria was : for Ec 74% in CP and 83% in AP patients; for Aa 37% in CP and 39% in AP patients; for Pg 16% in CP and 18% in AP patients. Subjects harbouring Ec had lower PI, SBI and CAL values. PTSD patients had the highest PI and SBI values, and concerning PD an CAL were similar to PP patients. The similar prevalence of periodontal pathogens in PTSD and PP subjects indicates PTSD subjects as a risk group for periodontal disease initiation or progression

Proinflammatory Factors in Saliva as Possible Markers for Periodontal Disease

Studies have indicated that host inflammatory proteins, enzymes and indicators of bone metabolism present in saliva differ in different types of periodontal disease. However, the number of markers analyzed was limited and the effect of edentulousness was not examined.We measured the concentration of host inflammatory proteins: C-reactive protein (CRP), C3 and C4 complement components, alpha-2-macroglobulin (a -2M) and tumor-necrosis factor (TNF) in unstimulated saliva of 14 periodontally healthy (PH), 9 edentulous persons (EP), 10 patients with chronic periodontitis (CP) and 18 with aggressive periodontitis (AgP). TNF was below the level of detection in all samples except one. Edentulous persons and patients with CP had significantly reduced concentrations of CRP, C3 and a -2M. Edentulous persons and AgP patients had lower C4 concentrations. We can conclude that edentulous persons and CP patients have reduced salivary concentrations of host inflammatory proteins. These findings suggest that a reduction in host responsiveness might play a role in the pathogenesis of CP

Membranes for Periodontal Regeneration

U ovome su članku prikazane različite vrste membrana za vođenu regeneraciju parodontnih tkiva. One se upotrebljavaju za pokrivanje defekata i poticanje regeneracije koštanih stijenki u parodontnome džepu. Membrana treba biti biokompatibilna i omogućiti da se stanice isključe kako bi se odvojio gingivni režanj od fibrinskoga ugruška te očuvao prostor za novu alveolnu kost i periodontni ligament. Membrane mogu biti resorbirajuće i neresorbirajuće. Neresorbirajuće membrane zahtijevaju drugi kirurški zahvat kako bi ih se uklonilo, zbog čega se sve manje upotrebljavaju. Većina tih membrana izrađuje se od politetrafluoretilena, kao na primjer Gore-Tex membrane. Resorbirajuće membrane skraćuju vrijeme liječenja, jer ih ne treba odstraniti nakon zahvata. Mogu biti od prirodnih materijala, pretežito od kolagena, i sintetičkih resorbirajučih materijala, najčešće derivata organskih alifatskih termoplastičnih polimera. Upotrebljava se poliglikolna i polilaktična kiselina. U tu skupinu spada Atrisorb membrana koja se pripravlja intraoperativno. Danas se ispituje i upotreba poliuretanskih membrana. Idealnih membrana nema. Do sada se najviše rabe kolagene membrane koje imaju najbolju biokompatibilnost, iako im se vrijeme razgradnje teško može predvidjeti.This article reviews different types of membranes for guided tissue regeneration. They are used to cover defects and stimulate regeneration of osseous defects in periodontal pockets. A membrane should be biocompatible, enable cell exclusion separating the gingival flap from the fibrine clot and guard space for the new alveolar bone and the periodontal ligament. Membrane can be non-resorbable and resorbable. When non resorbable membranes are used, another surgical procedure for their extraction is needed. They are therefore used less frequently today. The majority of these membranes are made of polytetrafluoretylene, e.g. Gore-Tex membrane. Resorbable membranes shorten the treatment since there is no need for their removal. They can be made from natural materials like collagen, laminar bone, dura mater or connective tissue transplants and from synthetic resorbable materials, most frequently derivatives of organic aliphatic thermoplastic polymers. Polyglycolic and polylactic acids are mostly used. This group includes the Atrisorb membrane that has to be prepared intraoperatively. The use of polyurethane membranes is presently being tested. So far the perfect membrane has not been discovered. Collagen membranes are most popular due to their optimal biocompatibility, although their rate of resorption is difficult to predict